arm rehabilitation study after stroke

Conditions: Stroke; Brain Infarction; Brain Ischemia; Cerebral Infarction; Cerebrovascular Disorders

Summary: this study is about arm and hand recovery after a stroke. the investigators are testing an experimental arm therapy called accelerated skill acquisition program (asap) which combines challenging, intensive and meaningful practice of tasks of the participant's choice compared to two standard types of therapy (usual and customary arm therapy totaling 30 hours and usual and customary arm therapy for a duration indicated on the therapy prescription). a second objective is to characterize current outpatient arm therapy (dosage \& content) following stroke for individuals who are eligible for icare. eligible candidates must have had a stroke affecting an arm within the last 106 days.

of the 700,000 individuals who experience a new or recurrent stroke each year, a majority have considerable residual disability. sixty-five percent (65%) of patients at 6 months are unable to incorporate the paretic hand effectively into daily activities. in turn, this degree of functional deficit contributes to a reduced quality of life after stroke. the extent of disability has been underplayed by the use of the barthel index that captures only basic activities of daily living such as self-care and does not extend to activities and participation at higher levels of functioning that are most affected by a residual upper extremity disability. the past decade has witnessed an explosion of different therapy interventions designed to capitalize on the brain's inherent capability to rewire and learn well into old age and more importantly for rehabilitation, after injury. the most effective arm-focused interventions with the strongest evidence and potentially the most immediate and cost-effective appeal for the current health-care environment share a common emphasis on focused task-specific training applied with an intensity higher than usual care. therefore, our primary aim is to compare the efficacy of a fully defined, hybrid combination of the most effective interventions (forced-use/constraint-induced therapy and skill-based/impairment-mitigating motor learning training), the accelerated skill acquisition program (asap), to an equivalent dose of usual and customary outpatient therapy.

Eligibility criteria:
inclusion ischemic or hemorrhagic stroke. hemiparesis in an upper extremity. age 21+. able to communicate in english (or spanish,rancho los amigos site only). willing to attend outpatient therapy \& f/u evaluations for 1 yr. some active finger extension. exclusion traumatic or non-vascular brain injury, subarachnoid hemorrhage, av malformation. history of psychiatric illness requiring hospitalization within past 24 mos. active drug treatment for dementia. neurologic condition that may affect motor response (e.g. parkinson's, als, ms). history of head trauma requiring \>48 hours of hospitalization within past 12 mos. amputation of all fingers or thumb of hemiparetic (weak) arm. treated with botox in affected arm within last 3 months.

Keywords: stroke hemiparesis physical therapy occupational therapy neurorehabilitation patient focused motor learning motor control skill acquisition skill training motor recovery task oriented training task specific training arm function hand function upper extremity arm therapy physical rehabilitation arm rehabilitation motor function